Ocul emergency-presentation
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Ocul emergency-presentation

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    Ocul emergency-presentation Ocul emergency-presentation Document Transcript

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    • class="ilink next-link" rel="nofollow">next</a></span><a href="#postComment" class="postCommentLink h-action-postcomment j-post-comment"rel="nofollow">Post a comment</a></p><ul class="commentWrapper h-comment-list" id="commentsList" ><li class="comment author-40152894" id="comment-1450718"><a href="/AdelHashem" class="notranslate commenter h-commenter j-author-photo"title="AdelHashem" rel="nofollow"><img class="nickname" src="//public.slidesharecdn.com/images/user-48x48.png"height="48" alt="AdelHashem" original="//cdn.slidesharecdn.com/profile-photo-AdelHashem-48x48" width="48" /><strong class="h-username j-username notranslate">Adel Hashem</strong><spanclass="bioStub notranslate"><span class="h-commenter-role">, اخصائى</span><span class="h-commenter-org"> at مركز جراØات العيÙàنÙàالليزر بمستشÙeى المطرية التعليمى</span></span></a><span class="commentText h-comment-text notranslate">thank you</span><span class="commentMeta h-comment-meta"><span class="commentTimestamp h-timestamp">1 month ago</span><span class="commentActions h-comment-actions hide"><button class="j-reply btn btn-mini">Reply</button></span></span><div class="alertMessage blockMessage warning" id="confirmDialog-1450718"><span class="title">Are you sure you want to</span><button class="btn btn-mini" id="yes">Yes</button><button class="btn btn-mini" id="no">No</button></div></li><li class="comment author-36924091" id="comment-1182433"><a href="/pirunratj" class="notranslate commenter h-commenter j-author-photo"title="pirunratj" rel="nofollow"><img class="nickname" src="//public.slidesharecdn.com/images/user-48x48.png"height="48" alt="pirunratj" original="//cdn.slidesharecdn.com/profile-photo-pirunratj-48x48" width="48" /><strong class="h-username j-username notranslate">pirunratj</strong><spanclass="bioStub notranslate"><span class="h-commenter-role"></span><span class="h-commenter-org"></span></span></a><span class="commentText h-comment-text notranslate">A lot of knowledge.Thanks</span><span class="commentMeta h-comment-meta"><span class="commentTimestamp h-timestamp">5 months ago</span><span class="commentActions h-comment-actions hide"><button class="j-reply btn btn-mini">Reply</button></span></span><div class="alertMessage blockMessage warning" id="confirmDialog-1182433"><span class="title">Are you sure you want to</span>
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    • <span class="favoriteMeta">3 years ago</span></li></ul><div class="viewMore action-morefavs j-favs-more" style="display:none"><a href="#"class="button" rel="nofollow">More&hellip;</a></div></div><!-- Favorites and Downloads end --><div class="notranslate transcript h-slideshow-transcript-bottom"><a rel="nofollow" id="text-version"></a><h2 class="h-slideshow-title"><span class="notranslate">Ocular Emergency</span>&mdash; Presentation Transcript</h2><ul class="transcripts h-transcripts"><li>Ocular Emergencies Pisit Preechawat, MDDepartment of Ophthalmology, Ramathibodi Hospital </li><li>Ocular Anatomy</li><li>1. Frontal bone 2. Zygomatic bone 3. Maxillary bone 4. Sphenoidbone 5. Ethmoid bone 6. Lacrimal bone 7. Palatine bone 1 2 3 4 5 6 7 BonyComponents of Orbit Size 30 x 40 x 45 mm </li><li>Paranasal Sinus</li><li>Ocular Anatomy Orbicularis Oculi </li><li>Ocular Anatomy </li><li>OcularAnatomy </li><li>Ocular Anatomy </li><li>Extraocular Muscles </li><li>Optic Nerve</li><li>Venous System </li><li>Ocular Emergencies Trauma Non - trauma Blunt traumaPenetrating trauma </li><li>Retinal arterial Perforation Orbital cellulitisocclusion Ruptured Orbital injury Chemical burns Acute glaucoma Cornealulcer Sudden congestion Corneal abrasion proptosis Hyphema Intraocular FBRetinal detachment Macular edema ( Immediately ) ( Within a few hours )( Within one day ) Acute Eye Conditions Emergency Very Urgent Urgent</li><li>Ocular condiitons requiring immediate treatment Acute Angle-ClosureGlaucoma Central Retinal Artery Occlusion Orbital Cellulitis Cavernous SinusThrombosis Endophthalmitis Retinal Detachment Toxic Causes of blindnessNontraumatic Ocular Emergencies Acute Dacryocystitis Acute Dacryoadenitis AcuteHordeolum Preseptal cellulitis Spontaneous subconjunctival hemorrhageConjunctivitis Bacterial corneal ulcer Viral keratoconjunctivitis Acute hydrops ofthe cornea Hyphema Uveitis ( iritis &amp; iridocyclitis ) Vitreous hemorrhageRetinal hemorrhage Central retinal vein occlusion Optic neuritis OcularEmergencies </li><li>Ocular burns and trauma Ocular Burn Alkali Burns Acid BurnsThermal Burns Burns Due to Ultraviolet Radiation Mechanical Trauma to the EyePenetrating or Perforating injuries Blunt Trauma to the Eye, Adnexa,&amp; Orbit 1.Ecchymosis of the Eyelids 2. Lacerations of the Eyelids 3. Orbital hemorrhage 4.Fracture of the Ethmoid bone 5. Blowout Fractures of the Floor of the Orbit 6.Corneal Abrasions 7. Corneal &amp; Conjunctival Foreign Bodies Ocular Emergencies</li><li>Eye Examination Visual acuity External Eye : orbit, periorbital skin,eyelids Confrontation visual fields Ocular motility </li><li>Anterior SegmentConjunctiva Cornea Anterior chamber Iris Lens Pupils : RAPD Eye Examination</li><li>A dilated pupil makes it easier to see the optic nerve, macula, and retina- 1% tropicamide ( Mydriacyl ) - 2.5% phenylephrine ( Neo-Synephrine ) FundusExamination PanOptic Ophthalmoscope Indirect Ophthalmoscope </li><li>Digitalpalpation Schiotz tonometer Intraocular Pressure Measurement </li><li>Ocular TraumaClosed Globe Open Globe Burn Contusion Laceration Laceration PenetratingPerforating Rupture </li><li><ul><li>Causes </li></ul><ul><li>Trauma, Hypertension</li></ul><ul><li>Valsava pressure spikes </li></ul><ul><li>Spontaneous</li></ul>No treatment Resolve within 2 weeks Subconjunctival Hemorrhage</li><li>Pain , photophobia , FB sensation, tearing Conjunctival injection,swollen eyelid Corneal Abrasion Epithelial staining defect with fluorescein</li><li><ul><li>Topical cycloplegia, ATB ointment </li></ul><ul><li>Pressurepatching for 24 hours </li></ul><ul><li>Searching for conjunctival foreign body</li></ul>Don’t apply PP if there is a significant risk of infection. CornealAbrasion : Management </li><li>Corneal Ulcer Hypopyon Eye Shield No patchingTopical antibiotics Ophthalmologist referral </li><li>Conjunctival Foreign Bodies</li><li>Corneal foreign body with rust ring Rust ring Corneal Foreign Bodies
    • </li><li><ul><li>Remove the FB under the best magnification </li></ul><ul><li>Evertthe eyelid to rule out additional FB </li></ul><ul><li>Treat resulting cornealabrasion </li></ul><ul><li>Referral to ophthalmologist, next day </li></ul>Residualrust ring Corneal Foreign Bodies </li><li>Corneal Foreign Body Removal</li><li><ul><li>Disruption of blood vessels in the iris or ciliary body</li></ul><ul><li>Blood in anterior chamber </li></ul>Traumatic Hyphema</li><li>Traumatic Hyphema : Classification Total IV 1/2 to less than totalIII 1/3 to 1/2 II Less than 1/3 I No layered blood circulating red bloodcells only 0 Size of Hyphema Grade </li><li>Traumatic Hyphema</li><li><ul><li>Elevate the patient’s head </li></ul><ul><li>Bed rest</li></ul><ul><li>1% atropine one drop 3-4 times daily </li></ul><ul><li>1%prednisolone acetate one drop 3-4 times daily </li></ul><ul><li>If the globe isintact, measure IOP </li></ul><ul><li>Reduce IOP </li></ul><ul><li>Ophthalmologyconsult </li></ul>Traumatic Hyphema : Management </li><li><ul><li>Rebleeding canoccur 3 to 5 days later in 30% </li></ul><ul><li>Uncontrolled glaucoma or bloodstained cornea </li></ul><ul><li>requires anterior chamber “wash out” </li></ul>Traumatic Hyphema : Management </li><li><ul><li>Sharp or blunt trauma</li></ul><ul><li>R/O associated ocular injury </li></ul><ul><li>Remove superficialFB </li></ul><ul><li>Rule out deeper FB </li></ul><ul><li>Give tetanus prophylaxis</li></ul>Lid Lacerations </li><li>Full Thickness Lid Lacerations - Gray line -Lash line - Mucocutaneous junction Tear lid margin </li><li>Laceration of lowereyelid margin Post-operative result following a primary repair Lid Margin Repair </li><li><ul><li>Refer to ophthalmologist if there are </li></ul><ul><li>associatedocular injuries </li></ul>Lid Lacerations <ul><li>Ruptured globe</li></ul><ul><li>Lacrimal drainage system </li></ul><ul><li>Levator aponeurosis </li></ul><ul><li>Medial canthal tendon </li></ul><ul><li>Tissue loss ( &gt; 1/3 ) </li></ul></li><li>Lid Lacerations with tear canaliculi </li><li>Canalicular Repair</li><li><ul><li>Woman with tearing and medial canthal asymmetry after the repairof a laceration sustained during a domestic assault </li></ul>Tear Canthal Tendon</li><li>Penetrating / Ruptured Globe <ul><li>Corneal or scleral lacerations</li></ul><ul><li>Hypotony (not always present) </li></ul><ul><li>Severe chemosis&amp; hemorrhage </li></ul><ul><li>Intraocular contents may be outside the globe </li></ul><ul><li>Limitation of extraocular motility </li></ul><ul><li>Shallowanterior chamber </li></ul><ul><li>Irregular pupil </li></ul></li><li>Irregularpupil </li><li>Penetrating / Ruptured Globe </li><li>Ruptured globe caused by golfball Penetrating / Ruptured Globe </li><li><ul><li>Stop examination</li></ul><ul><li>Shield the eye (do not patch) </li></ul><ul><li>Give tetanusprophylaxis </li></ul><ul><li>NPO and systemic antibiotics </li></ul><ul><li>Do notapply eye ointment or eye drop </li></ul><ul><li>Film orbit if IOFB can’t be R/O</li></ul><ul><li>Refer immediately to ophthalmologist </li></ul>Penetrating /Ruptured Globe : Management </li><li>Intraocular or Intraorbital Foreign Bodies </li><li>Ocular Trauma Traumatic cataract Traumatic mydriasis Traumatic lenssubluxation Traumatic lens subluxation </li><li><ul><li>True ocular emergency</li></ul><ul><li>Both acid and alkali burns can be blinding </li></ul><ul><li>-Acid burns tend to coagulate proteins, limiting </li></ul><ul><li>the depth ofpenetration. </li></ul><ul><li>- Alkali burns can rapidly penetrate the cornea,</li></ul><ul><li>causing damage to intraocular structures. </li></ul>ChemicalOcular Injury </li><li><ul><li>Immediate copious irrigation with a minimum of</li></ul><ul><li>1-2 L of saline or until pH is normalized ( 7.3-7.7 )</li></ul><ul><li>- Instill a topical anesthetic </li></ul><ul><li>- Use eyelidretractor </li></ul><ul><li>- Double eversion of the eyelids </li></ul>ChemicalOcular Injury : Management </li><li>Irrigation in case of chemical injury</li><li><ul><li>Immediate copious irrigation with a minimum of</li></ul><ul><li>1-2 L of saline or until pH is normalized ( 7.3-7.7 )</li></ul><ul><li>- Instill a topical anesthetic </li></ul><ul><li>- Use eyelidretractor </li></ul><ul><li>- Double eversion of the eyelids </li></ul>ChemicalOcular Injury : Management <ul><li>Ophthalmologists Referral </li></ul><ul><li>Nocorneal involvement </li></ul><ul><li>- ATB + steroid eye drop</li></ul></li><li>Chemical Ocular Injury : Classification Grade I Grade II Grade
    • III Grade IV </li><li>Chemical Ocular Injury : Management <ul><li>Preservative-free artificial tears </li></ul><ul><li>Topical non-preserved steroid</li></ul><ul><li>Topical cycloplegic </li></ul><ul><li>Topical antibiotics </li></ul><ul><li>Oral analgesics </li></ul><ul><li>Pressure patch or bandage CL</li></ul><ul><li>Antiglaucoma + </li></ul></li><li>Bilateral Alkali InjuriesChemical Ocular Injury </li><li>Chemical Ocular Injury : Management CornealTransplantation Keratoprosthesis </li><li><ul><li>Accidental into the eye can causethe lids to </li></ul><ul><li>adhere and adhesive clumps to form on the cornea</li></ul><ul><li>Not permanently harmful to the eye</li></ul><ul><li>Cyanoacrylates are used occasionally directly on the</li></ul><ul><li>cornea to seal corneal perforations. </li></ul>CyanoacrylateGlue </li><li><ul><li>Moisten the glue with eye ointment, and remove</li></ul><ul><li>as much as can be removed easily without causing</li></ul><ul><li>damage to underlying tissue </li></ul><ul><li>The glue willloosen and become easier to remove </li></ul><ul><li>in a few days.</li></ul>Cyanoacrylate Glue </li><li>Non-traumatic Ocular Emergencies </li><li>Thewoman suddenly experienced nausea, vomiting, and extreme pain in the left eye whilein a movie theater. Her vision has worsened since that time and the eye has becomevery red. A 55-year-old woman with a red eye, blurred vision with halos, nausea,and vomiting </li><li>VA - HM Conjunctival injection Hazy cornea Shallow anteriorchamber Fixed mid-dilated pupil A 55-year-old woman with a red eye, blurred visionwith halos, nausea, and vomiting Acute Angle Closure Glaucoma IOP 56 mmHg </li><li>AnteriorChamber Depth </li><li>Reduce the intraocular pressure O.5% Timolol 1 drop 2-4 %Pilocarpine 1 drop every 15 minutes 20% Mannitol 250-500 ml IV drip Acetazolamide500 mg oral 100% Glycerin 1 cc/kg Consult ophthalmologist Acute Angle ClosureGlaucoma </li><li>A 60-year-old woman with acute, painless loss of vision in theright eye Visual acuity CF – LP in 90% of cases Opaque white retina andattenuated vessels Central Retinal Artery Occlusion </li><li>Treatment must beinitiated immediately. Ocular massage Inhaled carbogen ( 95% O2 and 5% CO2 )Reduced intraocular pressure Central Retinal Artery Occlusion Consultophthalmologist immediately Anterior chamber paracentesis Direct infusion of t-PAor urokinase in the ophthalmic artery </li><li>A 40-year-old man with left eyelidedema and pain ( worse on eye movement ) </li><li>A 40-year-old man with lefteyelid edema and pain ( worse on eye movement ) <ul><li>Periorbital erythema andedema </li></ul><ul><li>Proptosis </li></ul><ul><li>Restricted extraocular motility</li></ul><ul><li>Decreased visual acuity </li></ul><ul><li>Chemosis</li></ul><ul><li>Fever </li></ul>Orbital Cellulitis </li><li>Broad spectrumintravenous antibiotics CT scan orbit Ophthalmology &amp; ENT consultation OrbitalCellulitis Subperiosteal abscess </li><li>Preseptal Cellulitis</li><li>Endophthalmitis </li><li>Urgent Neuro-ophthalmology </li><li>A 36-year-old-woman with subacute visual loss in right eye and pain on eye movement VA20/200, 20/25 RAPD +ve OD VF central scotoma OD Retrobulbar optic neuritis</li><li>A 55-year-old man with HT and acute visual loss in RE VA 20/100, 20/20RAPD +ve RE Nonarteritic anterior ischemic optic neuropathy ESR 10 mm/hr</li><li>A 73-year-old woman with acute visual loss of right eye, headache,anorexia and weight loss VA 10/200, 20/25 RAPD + ve RE ESR 94 mm/hr, high levelof C - reactive protein Arteritic anterior ischemic optic neuropathy</li><li>Pathology : Giant Cell ( Temporal ) Arteritis </li><li>A 35-year-old manwith left painful third nerve palsy VA 20/25, 20/30 Dilated, nonreactive pupilLE </li><li>A 35-year-old man with a suspicious of aneurysmal third nerve palsyConventional CT scan or MRI are not the procedure of choice High false negativerate 12 – 40 % Magnetic resonance angiography (MRA) Computed tomographyangiography (CTA) Overall sensitivity up to 97 % </li><li>A 35-year-old man with asuspicious of aneurysmal third nerve palsy </li><li>A 40-year-old woman withsudden onset of left third nerve palsy, visual loss and severe headache What isthe diagnosis? VA 20/30, LP +ve RAPD LE </li><li>Pituitary Apoplexy Characterizedby sudden visual loss, headache, and ophthalmoplegia secondary to rapid expansionof pituitary macroadenoma into the suprasellar space and/or cavernous sinus
    • Commonly results from hemorrhage into a pre-existing pituitary mass </li><li>A 17-year-old man with right blured vision after minor blunt trauma. VA 20/32, 20/20+ ve RAPD RE Normal fundi RE LE </li><li>A 16-year-old man with head injury andleft blured vision after falls from height VA 20/30, LP + ve RAPD LE Normalfundi </li><li>Traumatic Optic Neuropathy : Classification and Mechanisms Directinjury - Penetrating injury from knife, projectile - Injury from fractured bone- Avulsion, transection Indirect injury - Contusion with transmission of forcethrough bone - Compression secondary to orbital hemorrhage or intrasheathhemorrhage </li><li>Clinical Features of Traumatic Optic Neuropathy Most commonlyunilateral May be overlooked in setting of significant globe or maxillofacialtrauma Reduced visual acuity ( NLP to 20/20 ) Visual field defect : Nopathognomonic defect Normal optic disc with development of optic atrophy</li><li>Medical Management Options Steroids : Controversial - Thought to limitfree-radical amplification of the injury response - Dosages ( low, high, mega) -May be harmful Observation : 57% of untreated patients shown to have 3 lines ormore acuity improvement </li><li>Surgical Management Options Lateral canthotomy andcantholysis for orbital hemorrhage Surgical decompression of the optic nerve withinits canal There is no defined standard protocol of treatment for indirect opticnerve injury . </li><li>Thank you for your attention </li></ul></div><!-- .transcript --><div class="transcriptAd h-below-transcript-ad"><div class="transcriptAdDiv"><script type="text/javascript">GA_googleFillSlot("slideview_below_transcript");</script></div></div></div><!-- .assets --><footer><div class="footerWrapper"><div class="footer"><div class="footerLeft"><form class="footerSearch" method="get" action="/search/slideshow"><fieldset><input name="searchfrom" type="hidden" value="footer" /><div class="suggestionContainerFooter"><input name="q" class="text" id="search_query_bottom" type="text" value=""autocomplete="off" /><input class="ctaNormal" type="submit" value="Search" /></div></fieldset></form><!-- .social-links --><div class="social-links"><ul><li><a href="http://www.slideshare.net/mobile" class="iconMobileFooter"rel="nofollow">SlideShare <br /> on mobile</a></li><li><a href="http://twitter.com/SlideShare" class="iconTwitterFooter"rel="nofollow">Follow us on Twitter</a></li><li><a href="http://www.facebook.com/slideshare" class="iconFacebookFooter"rel="nofollow">Find us on Facebook</a></li><li><a href="http://slidesha.re/SlideShareOnLinkedIn" class="iconLinkedInFooter"rel="nofollow">Connect on LinkedIn</a></li></ul></div><!-- /.social-links --></div><div class="links footerRight"><div class="fColumn fColumnSmall"><ul class="linksList"><li><strong>Learn About Us</strong></li>
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